Don't be deceived. Contrary to popular opinion, ALL insurers, whether on or off the exchanges,

[pnwmom]

Last edited Wed Mar 19, 2014, 03:29 AM - Edit history (4)

must now follow the rules of the ACA. They can no longer deny people due to pre-existing conditions, dump them when they get sick, or not offer the Essential Benefits. Some people who have very specific needs -- such as a prescription medication that isn't offered on all formularies -- could be better off buying outside of an Exchange, through an insurance broker. However, if you need a subsidy, the only place to get one is on an Exchange.

If any insurance broker tells you that you will be denied by an insurer for a preexisting condition, he's either ignorant or lying. Either way, find another broker.

Also, if you know you need a certain expensive medication, you should contact insurers and see if it's on their formulary. That might be the deciding factor in what policy you choose. You can also ask an insurer what the alternative choice is for that class of drugs and then ask your doctor if it would be an acceptable substitute. If you already have an insurer and you're denied, there is an internal and external appeals process, as well as a way to request an exception. See below.

http://www.nytimes.com/2013/10/26/your-money/health-insurance-options-arent-limited-to-obamacare-exchanges.html?_r=0

In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.


http://www.insure.com/articles/healthinsurance/buying-health-insurance-outside-exchange.html?WT.qs_osrc=fxb-182807210

Drug coverage

Drug coverage is yet another variable. You may find you have more options when it comes to drug coverage if you shop off-exchange. Like provider networks, health plans can limit the drugs that are covered, or reimburse more for generics than brand-names, or reimburse more for drugs you buy mail-order than from your local pharmacy.
If you have a health condition and use a particular drug, you should check that it's covered under the plan in which you want to enroll, whether that plan is on the exchange or off-exchange, Coleman advises.
Remember, too, he says, the cap on out-of-pocket expenses doesn't apply to drugs not on a health plan's list of covered medications.

http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/

But yes, there are certain limits: a formulary, for instance, may cover three drugs for treating a certain condition but not two others. Obamacare — like all insurers currently operating in the market — has a fix for that. ACA regulations demand that a health plan must have an “exceptions process” in place that allows patients to request and gain access to clinically appropriate drugs that aren’t covered by the health plan (in addition to internal and external appeal processes). So, if a health plan does not cover a particular drug that a patient absolutely needs, their doctor can certify medical necessity to extend coverage. Insurers have relied on drug formularies before the law went into effect and already have exceptions processes in place, meaning that most “will not have to implement significant changes.”

In his piece, Gottlieb illustrates the narrowness of some formularies this way: “I found one plan in North Carolina that doesn’t cover Actonel for osteoporosis, Aubagio for multiple sclerosis, or Xeljanz for severe rheumatoid arthritis, among other ‘non formulary’ drugs.” But as Washington & Lee law professor Tim Jost points out, “This is the way formularies work, we’ve decided we’re going to cover these drugs, but not those drugs… I don’t think you can know anything from seeing what they list as the non formulary drugs without knowing what the formulary is and how fungible those drugs are with the formulary drugs.” Jost notes that drugs within the same category and class are more or less fungible, and so for most people, the drug that’s offered will work as well as the one that isn’t — and is often far cheaper than the name brand option.

[NYC_SKP]

1. But some think that Obama's worse than a used car salesman, or some shit like that. :eyes:

I take the more sober and rational point of view:

If under ACA you are not getting all the meds that you really should be getting, then you SURE as hell weren't getting them without ACA and it was almost certainly worse.

It's an arc, it moves in the direction of fairness and equity, it doesn't find a wormhole and happen over night.

Thanks for the post, I hope people read it.

[pnwmom]

5. Yeah I know. I thought I should put this out there where hopefully more people will see it

than buried in that thread.

[Texasgal]

9. I agree.

Anyone that thought ACA was perfect is not informed well.

It's gonna take ALOT more to fix our health insurance debacle. ACA was a start. Not a CURE.

[pnwmom]

11. But it is a start. And millions are already better off. We just have to be as smart as we can

in considering our options.

[okaawhatever]

29. And we have to be vigilant about fixing the problems with it, we can either strengthen the ACA and

our coverage or we can allow insurance and pharma to weaken it until we all give up what we fought so hard for.

[Doctor_J]

59. how are you going to fix the fact that big insurance takes 20% or more?

And that the outrageous cut is now the law of the land?

[jeff47]

66. By killing big insurance.

A "public option" plan is a pretty easy sale in blue states. Single-payer is possible in some, but more of a reach.

Either one results in concrete examples that destroy big insurance's FUD on the issue. And they'll be popular since they don't have that 20% premium, since they're not-for-profit. Which will result in more and more people switching to those plans. Which will destroy private insurance in those states - in addition to being non-profit, bigger risk pool means even lower costs.

Success in blue states can be used to destroy the FUD elsewhere, resulting in some purple states joining. Those states will follow the same path that eliminates or greatly reduces private insurance.

We can then return to the national battle in a much stronger position. Big insurance will have a lot less money and power, and we'll have fantastic examples of "government healthcare".

[Doctor_J]

68. this has to be some sort of joke

We just gave them 600 billion dollars. Now we're going to kill them?

The fan club has become impenetrable.

[jeff47]

72. You're free to point out where that plan won't work.

Of course, that requires doing things like claiming insurance companies have massive political power in Vermont. Btw, they're going single-payer in 2018, the first year the ACA allows it.

Yes, insurance companies got a great short-term bonus. Doesn't mean we have to cater to them forever.

[okaawhatever]

108. How did we give insurance companies 600 Billion dollars? nt

[Doctor_J]

124. The US HC industry is now 3 trillion per year. The ACA guarantees them 20% that JUST FOR PROFIT

do the math

[ProfessorGAC]

139. Did You Do It?

They were going to make that anyway, but now they can't make it by denying coverage or refusing procedures.
GAC

[Doctor_J]

146. er, not if there was a public option

they could compete with a Medicare-type plan, in which the overhead is 3%.

I just wish that the Fan Club would admit that the president sold out to Big Insurance, but that he had to. Stop trying to put lipstick on the pig. Wipe off the lipstick, look at the ugly pig underneath, and say, "yep, it sucks, but it's ours".

[pnwmom]

149. I prefer single-payer, but I don't think we should be spreading lies about the ACA here

or even sheer ignorance.

[pnwmom]

144. Administrative costs ARE NOT PROFIT.

And they must be no more than 15% for large group policies, and 20% for small group and individual. Administrative costs include all marketing and managing costs, with whatever is left over in that amount as profit.

The ACA is also helping to fund any states who want to try single payer, like Vermont, or co-ops, like Oregon.

[Doctor_J]

148. And a 5 million dollar bonus for a HC CEO is not health care

nor an administrative cost, nor profit.

[pnwmom]

150. Wrong. It's part of administrative costs. I don't agree with a bonus like that, but the insurer

still must keep total administrative costs to the level the law requires. 15 - 20%.

[Doctor_J]

185. So part of my new $50 copay goes toward the CEO's fifth home, legally

How can you not see that this is a travesty?

[pnwmom]

188. Switch insurers if you don't like yours. n/t

[Fantastic Anarchist]

192. To another whose CEO has six houses?

[pnwmom]

193. If that's what you prefer. n/t

[Fantastic Anarchist]

194. Well, I guess I have a choice everyone's talking about then.

Though limited it may be.

[yodermon]

153. It *LIMITS* them to 20%. It used to be however high the fuck they could make it. You'd prefer that??

[Doctor_J]

190. In return for every person in the US being a paying customer

[okaawhatever]

105. Considering that was a reduction in their profit, I'd say that is a win. Also, the 20% isn't

profit. It's their operating revenue. I don't know what percentage of that will end up being profit. I don't kid myself, I don't think America would have passed single payer, nor do I think the medical infrastructure is set up to handle it. Also, as a child of a military family, I want single payer with private options or private upgrades. I remember this one time I sick as a kid. My mom would always test to see if we were faking by saying we'd have to go to the ER. I was sick enough that I was willing to go to the local Air Force hospital (a very rare occurrence). We dropped my sister off when school started. After her walking home over a mile, she still beat me home that day. An entire school day plus an hour or so waiting.....every time I think of 100% single payer I think of that story (I have others).

I don't know if the ACA is the best possible solution, but I know it's a major start. Remember what happened when the Clintons tried to talk about health care reform in the 90's? The ACA is a major achievement no matter how you look at it. Obama never campaigned on single payer, so I'm not disappointed in him. The door is open and it's up to the citizens of the US to make this what we want it. There will never be legislation that is both fundamentally different from the status quo and completely accurate.

[Doctor_J]

125. I don't know where to start

I want single payer with private options or private upgrades.

During ampaign 2008 the president promised PO with private competition. He ridiculed his primary opponent for not insisting on the PO. Then before the ink was dry on his election, he cut SP advocates out of the discussion. That was a falsehood on his part. And your bizarre tale of walking uphill both ways to access SP doesn't mesh with what every single developed country except this one experiences now

Obama never campaigned on single payer, so I'm not disappointed in him.

2008 Campaign: I will insist on a public option to keep the insurance companies honest
2009 ACA pitch: We need all of that overhead. Your friends and relatives depend on those jobs.
2010 Mid-terms: Wow! Where did all those 2008 voters go?

I don't know if the ACA is the best possible solution, but I know it's a major start...is a major achievement no matter how you look at it.

It is the Gingrinch plan from 20 years ago, devised by the right-wing Heritage Foundation. I guess you could classify it as a major achievement - in the wrong direction.

The door is open and it's up to the citizens of the US to make this what we want it. There will never be legislation that is both fundamentally different from the status quo and completely accurate.

The door was closed when the ACA was signed into law. It made Big Insurance part of the government. It's not going away during the lifetime of anyone currently breathing.

[pnwmom]

151. Ted Kennedy's death changed everything. He was replaced by a Rethug in MA

and we lost the biggest force we'd ever had in Congress for health care. We were barely able to put together the 60 votes we needed for even the ACA. Lieberman, of CT, the national headquarters of insurance companies , was the hold-out against a public option. At that point he had switched parties to the Independent party, after winning against an opponent who supported the public option.

We couldn't pass the ACA without his vote, so that's how we lost the public option. Blame Lieberman and Congress, not Obama.

[pnwmom]

141. Not true.

It used to be "20% or more." Now administrative costs, including marketing, must be kept below 20% for small group and individual policies, which obviously will take more work, and below 15% for large group policies.

I would have preferred Medicare for all, but this is a significant improvement over the status quo, which had no limits.

[pnwmom]

142. They don't. Large insurers must keep administrative costs below 15%

and small group and individual, BELOW 20%.

By the law of the land, there used to be no limit; now there is.

[Doctor_J]

186. Ok, 400 billion instead of 600 billion

I take back everything I said.

[pnwmom]

187. You're been pretending that all 20% is profit, which is blatantly untrue. n/t

[Doctor_J]

189. I consider 10-figure CEO bonuses profit.

if you want to classify them as something else, bully! I don't think they should be part of my expenses for health care

[pnwmom]

191. Then switch companies. n/t

[Doctor_J]

195. Would love to. Can you point me to the one with 3% overhead like Medicare?

[brush]

180. They were taking much more than that before. nt

[Cha]

12. Right.. like Raging Misplaced Anger would help solve the problem. That

was the most ridiculous piece of public hissyfit I've seen from the "anger is a gift" guy. Misplaced Anger Needs Anger Management classes.

[Whisp]

16. what that sounded like is someone didn't do their homework

and is blaming 'piece of shit used car salesman Obama' because that's easier and it will get recs.

[Cha]

18. Exactly.. same with this one..

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4688008

Except for the RECS part.

[JEB]

63. And a beautiful arc it is,

unless it's your loved one dying.

[ProSense]

2. There is also this:

Appealing Health Plan Decisions

The Affordable Care Act ensures your right to appeal health insurance plan decisions--to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”

http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html

[pnwmom]

3. Thanks, ProSense! That's important for people to know about. n/t

[TheKentuckian]

104. That was the deal pre reform, at least in the majority of policies.

It is great that the process is now uniform because there were some worms hiding under rocks bullying the shit out of people usually paying a pretty penny for some shoddy coverage with little or no recourse.

Solid tinkering.

[treestar]

120. What gets me is a single payer system might also deny certain treatments or drugs

And also would have an appeal system for it. So that's not even the issue.

[pnwmom]

162. Right. Canada and the UK have single payer with formularies.

Our Medicare and Medicaid have formularies. This isn't an issue particular to the ACA.

[malaise]

197. Where have you been?

Welcome back

[mopinko]

198. yeah, i wanna know too.

where you been?
so good to see you here!

[Fumesucker]

4. The upshot of this being what?

Those who have expensive diseases pay a lot more for insurance?

[pnwmom]

8. The upshot is that you shouldn't give up before checking out the drug formularies

in all the plans available in your region, both on and off the exchanges.

And that you shouldn't trust an insurance salesman who has given you verifiably false information.

[Fumesucker]

13. Just to be clear, it won't cost more for your coverage if you have an expensive disease?

Everyone pays the same, right?

[Lex]

27. More doctor visits and more medicines to buy = more money to be paid.

That's not going to change with ACA. There would be a yearly cap, however.

[pnwmom]

28. They can't charge you higher premiums because you have an expensive disease.

And if you require an expensive medication, you should check the various companies drug formularies before you sign on. But no insurer can fail to provide appropriate medication for whole categories of illnesses.

[Fumesucker]

41. "no insurer can fail to provide appropriate medication for whole categories of illnesses"

What does that mean?

[pnwmom]

44. It means that they might be able to tell you, if you need an aromatase inhibitor,

that you can get one -- but not necessarily the one you've been taking. Or that you can get the generic but not the brand name. But they can't say they don't cover aromatase inhibitors as a category.

[Fumesucker]

51. An aromatase inhibitor is an aromatase inhibitor?

Do people care which aromatase inhibitor they get?

More importantly, should they care?

[pnwmom]

54. Some people might. Some people might with any drug category. n/t

[Lars39]

60. Been on them 9.5 years.

Different people tolerate the side effects differently. Took several tries before I landed on one that I could tolerate. I would not want to lightly give up a drug that was working and that I could tolerate. Just my 2 cents.

[pnwmom]

140. Unfortunately, formularies aren't something specific to the ACA. Medicare has a formulary,

the Canadian and UK systems have formularies -- I don't know of any large system that doesn't. It has nothing to do with single payer vs. insurance companies. It's a pretty universal cost saving method.

[Lars39]

143. Formularies should be standard from company to company.

No reason on this earth to have to change a medication that is working just because you switch insurance companies.

[pnwmom]

145. Each company negotiates prices with the drug companies. There's no universal pricing.

Unfortunately the Rethugs blocked bills that would have allowed Medicare and Medicaid to negotiate for better prices, as other countries do.

[Lars39]

147. And that is why we are sitting ducks.

[pnwmom]

161. Medicare and Medicaid use formularies. So do the national health systems

in Canada and Britain. Do you know of any systems that don't use formularies?

[Lars39]

165. Making formularies standard from one ins co to the next would cut costs, ie profit.

It would also end a lot of stress and confusion for people.

[pnwmom]

167. It would also give people fewer choices. As it stands now, if one insurer doesn't cover your

medication, another might.

[Lars39]

168. It is not set in stone that it would have to be that way.

[pnwmom]

169. Please name one single-payer system anywhere in the world that doesn't have a formulary

that excludes some drugs.

They all do this to save money, because drugs are made by private companies who are trying to squeeze out every dollar of profit they can.

[Lars39]

170. That does not mean that we could not have the improvements.

We could lead the way.

[pnwmom]

171. Of course. Everything could be improved. But we need to be clear on what the issue is.

It's not the ACA.

[Lars39]

173. Er, yes, it is. What would be one more law or three that insurance companies

would have to follow in in order to e ACA compliant?

[pnwmom]

175. The ACA could be amended, yes. But the ACA didn't invent formularies,

and they're not exclusive to private insurers. When I worked for the state, my prescriptions had to be listed on a formulary, and Medicare and Medicaid people get theirs prescribed from formularies, too.

[mopinko]

199. formularies is how we can reduce drug prices. you use them to

negotiate.
when people talking about medicare negotiating drug prices, they mean changing the prices for their formulary. and standardizing prices.
some add ons have very different deals. they could be made to standardize them all.
this is what bernie wants to do. it would be a great addition to the law.

there is so much more in the aca than the exchanges. it is a shame even here, like everywhere, people dont know the ins and outs.
you can tell who still has good private insurance and who doesnt.

[blindersoff]

160. but for MS drugs...

there are no generics (at least for the main ones). So it's not as simple as just choosing a generic of what you've been on.

[pnwmom]

201. No, it isn't. If a brand name is the only standard treatment, then it's supposed to be covered. n/t

[theboss]

164. Should all pills be free?

How do we get more pills then?

[geek tragedy]

15. that people having issues with insurance companies have to fight them and shop around

my wife's insurance company initially denied her request for coverage for the insurance that keeps her alive, she and her doctor appealed and scrapped, and won.

people act like nobody's insurance company denied coverage for treatment before the ACA.

insurance companies publish their formularies.

[Fumesucker]

21. Just to be clear, it won't cost more for your coverage if you have an expensive disease?

Everyone pays the same, yes?

[geek tragedy]

25. "everyone pays the same"

well, no, people pay different amounts depending on where they live, how old they are, their employer contribution, what kind of plan/level of service they select, their level of income, whether they smoke

[Fumesucker]

34. All else being equal, the expensive patient pays no more for coverage?

I'm talking about premiums here, everyone knows the expensive patient is going to be out of pocket more than the person who never gets sick.

[geek tragedy]

37. you're asking a question as if you know the answer.

what you're stating is the general principle behind the ACA, but I'm sure you're sitting on a link you think debunks that, so go ahead and post it.

[Lex]

40. It's cuter, I guess, if he asks the question 12 times first. nt

[Fumesucker]

46. Do we all have to be insurance experts now?

That's the kind of question people I know in real life who don't follow politics ask me and I can't tell them for sure because I don't know myself.

I have my own areas of expertise and they don't include the minutia of insurance but I've had enough experience with them to trust them as far as so many mobsters, maybe less.

[geek tragedy]

50. as in all things, the more you know the better off you'll be

not everyone knows the ins and outs of home finance, etc.

for the healthy and young, they have the privilege of not needing to understand it

"everyone pays the same" is a political question--"what will I pay and what coverage will I get" is what consumers need to know

[Fumesucker]

58. You don't need to know your coworker's income

How much will I make and what are the requirements are all you need to know.

It doesn't matter at all if the person right next to you doing the same job as you makes twice what you do.

[pnwmom]

47. Premiums for the same plans are the same for all customers, regardless of health,

except that older people pay more than younger people (I think there are 3 age levels), and smokers more than non-smokers.

And the maximum out of pocket costs are also the same; though, as you pointed out, actual out of pocket will differ by how much a policy is used.

[Fumesucker]

64. I'm kind of the go-to person among some of the people I know for news type info

People in my real life are asking and saying things like this, at least the ones who can breathe through their noses.

I guess my point is that what plan you pick depends on your health and the ones for the less healthy are going to be more expensive or I'll be quite surprised.

The whole idea behind insurance is to get the largest risk pool possible to average out the bad luck with the good and this seems to defeat the very purpose of getting a large risk pool.

[jeff47]

71. There are no plans for the less healthy

There are plans. They are for everyone.

The balance of premiums, co-pays and out-of-pocket limits vary between those plans. Which plan is best for an individual will depend on a host of factors, from how you will be using the plan to the doctor network and the formulary. But that doesn't result in "plans for the less healthy". Each "less healthy" will make choices based on a host of factors. As a result, they will not end up in the same plan.

[Fumesucker]

73. In other words everyone has to become insurance experts

I can't think of anything more dreary than the minutia of insurance, it's entirely artificial and has nothing to do with the natural world.

The sheer amount of time and energy wasted over this is mind boggling, never mind the money.

[jeff47]

75. Not nearly as hard as you are claiming.

If you have a condition that requires frequent treatment, you are very aware of what doctors you will be seeing and what drugs you will be taking. It's trivial to consider that when you look at the plans in your area.

If you don't have a condition that requires frequent treatment, you really don't have any idea what your medical expenses will be. So you're going to pick a plan based on other easy-to-handle factors. Like "is my GP in that plan?"

[Fumesucker]

78. Just finding out what you actually have can take a very long time

I've had fairly severe symptoms in the past that the doctors never would commit to so much as hazard a guess and they just went away, no diagnosis ever made.

[jeff47]

79. K, that means you'll be in the latter group.

Pick a plan that has your GP or other doctors you like. If you don't have any, decide if you want a large pool of doctors or a small pool of doctors to chose from. Look at your finances and balance monthly expense vs. out-of-pocket risk.

Boy, that really required studying for months and almost becoming an actuary.

[Fumesucker]

83. And if the symptoms return?

Not all of us are prescient like yourself.

[jeff47]

93. Then you deal with it in your chosen plan for the rest of 2014.

And you re-evaluate your 2015 choices based on your new chronic condition.

Again, this is not nearly as hard as you are pretending it is.

[pnwmom]

100. I'd start by calling up your primary care doctor and ask what plans they take.

Or you could even find that information on line. I found it online first, and then checked the websites of the insurers to make sure they had the docs on the list, too.

The particular doctors and hospitals were the most important thing to me, but maybe you have other priorities.

[pnwmom]

99. Not really. Everyone who has a doctor already should ask the doctor

what plans they accept. That's how we started, anyway.

Then you compare the plans. If there's a hospital you want to be covered, then check on that. If you care about chiropractors or whatever, check to see if the coverage varies.

Once you know which insurer will work best for you, the difference between a bronze plan and a gold is that the bronze plan charges less every month, but you will have a higher deductible. People who want to "self-insure" choose the bronze plans.

The other reason no one has to become an expert is because the ACA is paying people called navigators to help people through the system. All anyone has to do is go on the website and find a telephone number there, and they can talk to a real live human being who will walk them through the process.

[pnwmom]

98. Prepare to be surprised then. That is no longer how it works. This is the whole point of getting

as large a risk pool as possible, including healthy people and unhealthy people -- so you can get good insurance, no matter what your present health status. You could have cancer, you could have a gene for Huntington's disease, you could be pregnant -- as long as you apply by March 31, you will be covered . And you will pay the exact same premium for the gold or silver or bronze policy that you choose, as anyone else in your age category or smoking status.

They are no longer segmenting people into small risks groups depending on their health or genes. Only age and smoking status will be a factor.

But this opportunity will go away on March 31 and won't come back till next December. They won't allow continuous enrollment, because that would encourage people not to sign up until they go sick. Anyone who doesn't sign up now risks going without insurance between now and the end of the year.

http://www.webmd.com/health-insurance/health-reform-insurance-for-pre-existing-conditions

Q: Will there be a limit as to how high a premium insurance companies can charge if you have a pre-existing condition?

A: Yes. As of 2014, insurers cannot charge consumers different rates for health insurance because of health status or gender.
You can be charged more for your age, however, with older people paying a higher premium than young people. But that increased charge is capped at no more than three times the standard rate.

SNIP

For health plans beginning after Sept. 23, 2010, insurance companies can no longer impose lifetime limits on benefits. That’s a big deal for people with serious illnesses, such as lung cancer, or other chronic conditions requiring ongoing and/or very expensive care.
Since the Affordable Care Act was passed in March 2010, many threats to repeal the law have been made. In fact, in January 2011, the House of Representatives did vote to repeal the Affordable Care Act, a measure that was rejected by the Senate. That means that the benefits gained thus far under the law are still in place.

SNIP

Q: Will the definition of pre-existing conditions change by 2014, when the Affordable Care Act goes into full effect?
A: A pre-existing condition is generally considered an illness or disability a person has prior to applying for health insurance coverage. Currently, the definition varies among states and even by insurance plans.
However, once the law takes full effect in 2014, that definition will lose its importance. Under the law, no one can be denied health care insurance for any reason, including an existing medical condition.

[treestar]

121. Or as if there is any possible system that might not deny coverage

Even a single payer system might have instances where you'd have to appeal. These are the details in which the devil resides. But that is always going to happen.

[pnwmom]

10. Of course not. I'm saying don't give up if the first company you look at doesn't offer what you need

If you have a range of choices, you should look into all of them.

It's not too late for people to even change plans if they have to.

[Cha]

14. "I LOATHE Obama".. well, aren't you a special little piece

of ignorance.

[flamingdem]

20. Tell us how you really feel?!

[Cha]

31. Just responding to a perfect example of ODS..

[flamingdem]

36. hola! I just posted the jury results down below, here they are

again:

* Obama did what no other pres has done, an amazing achievement considering the mafia insurance gang

Are you denying that people have no issues with them, then?
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4688008

REASON FOR ALERT

This post is disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate.

ALERTER'S COMMENTS

"Obama can go to hell" and "I LOATHE Obama. He is worse than a republican....". This is extremely OTT for a democratic website. Disruptive, rude and otherwise inappropriate. Please, DU. We are democrats and liberals. Don't tolerate this. Dissent is fine, but this is outrageous.

JURY RESULTS

You served on a randomly-selected Jury of DU members which reviewed this post. The review was completed at Tue Mar 18, 2014, 10:55 PM, and the Jury voted 4-2 to HIDE IT.

Juror #1 voted to LEAVE IT ALONE
Explanation: The community standards are to protect the community, not politicians.
Juror #2 voted to LEAVE IT ALONE
Explanation: I came very close to voting to hide this, but I understand that feelings are running very high right now over frustrations with the ACA. I think blaming Obama is unfair to the extent that the ACA was probably the best that was politically achievable, and I don't agree with the over-the-top criticisms of him, but I think people should be allowed some slack to vent their extreme frustrations over this issue.
Juror #3 voted to HIDE IT
Explanation: Basically arguing that we ought to have voted for McCain or Romney. I can see being critical of a Dem in office but not to the point of saying any Repub would be better then the Democrat being discussed.
Juror #4 voted to HIDE IT
Explanation: I know some people have a problem with ACA but jesus christ can we be civil about it? I hope you take this opportunity to take a break and clear your mind. You have issues
Juror #5 voted to HIDE IT
Explanation: Yeah, I'm getting sick of the reflexive Obama-hating.
Juror #6 voted to HIDE IT
Explanation: Hide this one with a pizza please.

Thank you very much for participating in our Jury system, and we hope you will be able to participate again in the future.

[Cha]

43. Aha! One and Two need to pay attention to #3.

thanks, flamingdem. I wouldn't even alert on that.. if people want to flaunt their ODS.. that's their problem. But, it actually is nice to see the jury hide his stupid hate.

[nadinbrzezinski]

23. You know, I have heard that sentiment in the flesh so many times

Now, that I wish I got a buck each time. It be a nice income by now. You ignore that at your peril. And I mean as principal income by the way.

[SunsetDreams]

45. The Jury results are in...

AUTOMATED MESSAGE: Results of your Jury Service
Mail Message
On Tue Mar 18, 2014, 07:55 PM an alert was sent on the following post:

"I LOATHE Obama".. well, aren't you a special little piece
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4688045

REASON FOR ALERT

This post is disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate.

ALERTER'S COMMENTS

This member has made multiple personal attacks in more than one thread today. Why is it being tolerated?

You served on a randomly-selected Jury of DU members which reviewed this post. The review was completed at Tue Mar 18, 2014, 08:07 PM, and the Jury voted 1-5 to LEAVE IT.

Juror #1 voted to LEAVE IT ALONE
Explanation: Are you kidding me? The post that Cha is replying to was hidden by a Jury. I think the response is appropriate.
Juror #2 voted to LEAVE IT ALONE
Explanation: No explanation given
Juror #3 voted to LEAVE IT ALONE
Explanation: No explanation given
Juror #4 voted to HIDE IT
Explanation: I understand the poster's frustration, but he/she should have expressed it without the personal attack.
Juror #5 voted to LEAVE IT ALONE
Explanation: I am going to cut anybody with 139 thousand posts a lot of slack for longevity in a highly judgmental environment. Besides, I wouldn't have voted to hide the post this post responds to, so how can I vote to hide this post?
Juror #6 voted to LEAVE IT ALONE
Explanation: I'm only looking at this post, and while it does appear to be a personal attack it is not completely out of line with the post (now hidden) that it is responding to.

Thank you very much for participating in our Jury system, and we hope you will be able to participate again in the future.

[Cha]

57. Brawawawaaaaaaa.. I thought you were going to give me the results of

The Obama Loather! ROFL WHEW..

I called him a piece of ignorance.. wow.. some people are a lit-tle touchy.

Thanks SunsetDreams!

[SunsetDreams]

62. LOL

I couldn't believe my eyes. I understand criticism where it is warranted, but to say that you "loathe Obama", that kind of takes it to a whole new level on DU. I can understand a post like that garnering responses such as yours on a site called Democratic Underground.

[Cha]

69. And, that wasn't all he had to say..

"He is worse than a Republican.." "..So yeah, Obama can go to hell..." The Stupid was Burning with that one.

I think "ignorance" hit it in my most euphemistic way.

[Jamaal510]

123. I'm surprised

his/her profile hasn't gotten deleted yet after that comment. That person basically openly violated a couple of the golden rules of DU in regards to Obama hatred and making light of how toxic the GOP agenda is.

[geek tragedy]

17. Thank you for the reminder that some people lie when they say they

don't hate President Obama.

Criticism does not equal hate.

Yes, there is actual hate, but it comes from the right. I do not wish to minimize that.

However, every time there is substantive criticism of Obama's policies (some of which actually are Bush's policies, held over, whether you choose to acknowledge that or not), such criticism is equated to hate, which is absurd.

My vote and support is ENTIRELY dependent on what they do and say during the campaign as well as what they do after being elected. I do not and will not simply vote for someone because they happen to have a D after their name. And that includes the president.

For me, Obama has been mostly disappointing. I would not vote for him again, given the opportunity. But that doesn't mean I hate him. I don't like him much as a politician. As a person, I'm sure he's nice enough.

http://sync.democraticunderground.com/?com=view_post&forum=1002&pid=4540963

You can go sit next to Ted Nugent

[Cha]

30. Precisely geek. Haters gonna hate and a perfect example of ODS.

[pnwmom]

49. Well, now s/he's been unmasked.

[Whisp]

7. thank you for that valuable INFORMATION

Apparently some people get hives when confronted with valuable information that Could Matter to their situation but prefer to smear their diarrhea instead.

[nadinbrzezinski]

19. FYI, some conditions will hardly be in standard formularies

Because they are expensive. This is when three things need to happen at the same time, and they should not.

1.- take a deep breath.

2.- Contact your federal delegation. They have constituent services that are supposed to help with shit like this.

3.- contact insurance commissioner for the state in question.

And a fourth step also needs to happen next, appeal the formulary.

I know that coming from me this is less valuable than bird droppings. But...if need to vent, that comes after that.

Oh and we need single payer system, insert cutesy name here. The ACA will only delay that.

[Fumesucker]

26. The insurance companies know damn well a lot of people aren't going to do that

Which is precisely why this game is being played.

And we though Goldman Sachs was a vampire squid.. Those were the good old days.

[Lars39]

35. And the time involved can wipe out your savings

or starve you if you don't have any, and if you've totally run out of money and medication you run the very real chance of your physical condition worsening. Not to mention the mental stress...

[zeemike]

74. Well face it, they are the little people

And they don't count for nothing...and I guess from what I read here they are little people because they are not smart enough to study insurance and make good choices between something they cannot afford and something that will break them financially.

It is not about getting people health care it is about selling them insurance.

[Lars39]

77. So true. Wait, is this where I'm supposed to

accuse you of wanting Mitt or Gramps for prez?

A lot of people here seem to have been behind the door when compassion was handed out.

[SammyWinstonJack]

177. Talk about adding insult to injury, just to defend Obama

...and I guess from what I have read here they are the little people because they are not smart enough to study insurance and make good choices between something they cannot afford and something that will break them financially.

[pnwmom]

38. Even under a single payer system, like Medicare, there can be formularies.

I prefer single payer, too, but it won't solve every problem with the health care system.

[nadinbrzezinski]

42. Yes, but I am not talking Medicare, or tricare, the closest we get to

Single payer, or for that matter the VA.

I am talking Israel, Canada, Costa Rica, all have better care, and cheaper than the US with better outcomes. Quite frankly we need to look outside our borders. It won't happen as long as the system works for the industries it serves, not the American people.

Notice, I am not blaming any president. I am blaming the system. The system is utterly dysfunctional, rigged and all that. And while one party is worst, they both are at it. Notice pols who work for the people remain as mostly back benchers.

We have been here before. I am not sure we will be able to recapture the political system form corporations and oligarchs this time though. So a farce it is, and we are far from exceptional. The ACA will reveal levels of cronyism, mark my words.

[pnwmom]

48. I wonder if they use formularies in Canada? Anyone know?

[nadinbrzezinski]

52. Everybody does

The difference is they are guides. They are not written in mostly stone.

If you have somebody with an expensive disease to treat. The OP in question is an expensive disease to treat, patients are not excluded. You believe that professor Hawkin would have fared well under the American system, even after the ACA? I am positive that he would not. The NhS provides for expensive live in care even. His meds are expensive as hell, and that computer that translates his thought to language, is paid by NHS. We are talking millions here.

[pnwmom]

56. Yeah, he's definitely better off there. I was also reading something recently

about France, and specialists making house calls. Amazing, compared to our system.

[nadinbrzezinski]

61. And Italy.

Last edited Wed Mar 19, 2014, 01:36 AM - Edit history (1)

They give patients with celiacs a stipend to buy their gluten free food.

You want a system that sort of works but should be a warning to us? And there is where I think we are moving. That be Mexico. The social security system (think NHS) is woefully undercapitalized. Not everybody qualifies, there is a second public sector that is even more under capitalized. I am betting the seguro popular, introduced last administration, will be woefully under capitalized.

The private sector is a hodgepodge ranging from ok care to nightmares.

That is where I fear we are moving. We are there to a point, several states don't have a rural medical system to speak off. Hell, my county is a microcosm, and this state still invests in medical care. Urban areas are well served. Don't get hurt east of El Cajon. Or woe getting sick as well.

So that should be a warning. And to those who control the system, they like the income.

Is ACA an improvement? Yup...but we really have a long way to go.

By the way, here are the rankings.

http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

We need more recent data, but I doubt much changed.

[MADem]

106. Spend some time in an Italian hospital before you boast about how great they are.

I'd take my chances in the worst US hospital for many conditions, particularly if I were unfortunate enough to find myself on the wards.

If you don't have a family member to come bring you food and clean sheets, you might not get a decent meal or sleep on clean sheets.

Nursing care in Italy is augmented to an ENORMOUS extent by "mama" or "sorella" or "fratello." And I am not kidding on that score.

[mopinko]

200. i meet w people every week at hospice that deny your claims.

many of them have been through a long and incredible struggle.
true as it is that many do not get that kind of care, more do.
like hawkin, they have family or good friends to advocate for them. even under single payer there are choices and disputes. someone w an advocate can get the best that is out there.
people w/o a lot of advocacy can more often get what they need because of the aca.

obvious exception is red state hell, but if we are talking about people who have policies through the exchanges, they are pretty well protected.
and the aca has "lifted all boats" by upgrading the quality of care available, and imho most importantly, has instituted feedback loops and quality of care research to establish best practices.

nurses on the hospice unit have been freed from many drug protocols and can better manage pain. they can get paid for time spent discussing end of life issues. that one is huge.
vaccines w/o copays. more primary care.

there is a lot in there that is based on improving public health, which obviously affects everyone for the better. lover and haters alike.

you can look at the world through a dark lens if you want, but it is not giving you an accurate picture.

[Recursion]

55. Of course they do. If you haven't nationalized pharma you have to have a formulary

Here it is: http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/provide-fournir/pharma-prod/med-list/index-eng.php

[treestar]

122. +1

And the public option, too. This is not even the issue. Just one person claiming they can't get what they want. We don't even know if it's true, or reasonable and can't know that. Just like the many anecdotal claims people make on the internet.

[Skip Intro]

22. They can't dump you when you get sick but can deny life-saving meds?

I'm not sure those two statements can live in the same reality.

[pnwmom]

33. Like Medicare, they can't deny all standard medications for any particular condition

but they can have formularies of their approved choices in each category.

[Cha]

24. Thank you for this good advice, pnwmom.. Valuable Things to know about your

health insurance plans.

[flamingdem]

32. Glad that DU in the grand majority supports the ACA and the HUGE efforts on the part of Obama

and many others to work against a mafia like industry and pave the way for a better system in the future.


-----

Are you denying that people have no issues with them, then?
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4688008

REASON FOR ALERT

This post is disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate.

ALERTER'S COMMENTS

"Obama can go to hell" and "I LOATHE Obama. He is worse than a republican....". This is extremely OTT for a democratic website. Disruptive, rude and otherwise inappropriate. Please, DU. We are democrats and liberals. Don't tolerate this. Dissent is fine, but this is outrageous.

JURY RESULTS

You served on a randomly-selected Jury of DU members which reviewed this post. The review was completed at Tue Mar 18, 2014, 10:55 PM, and the Jury voted 4-2 to HIDE IT.

Juror #1 voted to LEAVE IT ALONE
Explanation: The community standards are to protect the community, not politicians.
Juror #2 voted to LEAVE IT ALONE
Explanation: I came very close to voting to hide this, but I understand that feelings are running very high right now over frustrations with the ACA. I think blaming Obama is unfair to the extent that the ACA was probably the best that was politically achievable, and I don't agree with the over-the-top criticisms of him, but I think people should be allowed some slack to vent their extreme frustrations over this issue.
Juror #3 voted to HIDE IT
Explanation: Basically arguing that we ought to have voted for McCain or Romney. I can see being critical of a Dem in office but not to the point of saying any Repub would be better then the Democrat being discussed.
Juror #4 voted to HIDE IT
Explanation: I know some people have a problem with ACA but jesus christ can we be civil about it? I hope you take this opportunity to take a break and clear your mind. You have issues
Juror #5 voted to HIDE IT
Explanation: Yeah, I'm getting sick of the reflexive Obama-hating.
Juror #6 voted to HIDE IT
Explanation: Hide this one with a pizza please.

Thank you very much for participating in our Jury system, and we hope you will be able to participate again in the future.

[okaawhatever]

39. Thanks for posting this. I can't even stomach what some people write. It says absolutely nothing

about the President and everything about them. I understand how many individuals can be misinformed, but to post that vile rant is not the way to get better information.

[JEB]

53. Brokers are all out to sell, sell, sell

their favored product. Too many variables between policies and potential health problems to make a logical decision. Just gambling with your health and savings.

[sir pball]

65. I just signed up for my plan at work and noticed the preexisting small print

Actually quite large, and bold...anyway, preexisting conditions are not a disqualifier, but "are not covered" (exact words) for twelve months.

I have nothing PE besides my keratoconus which doesn't count since it's an eye disorder and my vision plan covers it as routine care, but I thought it worth mentioning. And yes, my health plan is ACA compliant, we had a company wide meeting to discuss the changes it entailed...so apparently while they have to accept you, they can wait for you to die first.

[Lars39]

70. That doesn't sound right.

https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/

[sir pball]

80. My plan MAY be grandfathered.

The excellent plan at my last job was grandfathered and I know they covered PEs with a 6 month window. It wouldn't surprise me if my current plan is in the same vein. Do you know the requirements for grandfathering?

[Lars39]

82. According to that link, the only grandfathered plan

is one you buy yourself, not one you get thru your employer. https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/

[sir pball]

95. Well either the link is wrong or Blue Cross/Blue Shield is. I honestly think the former.

My former plan was BCBS and explicitly grandfathered; I got a large book via Registered mail explaining why it was grandfathered, all the details, and would I please initial here here here and here, and sign and date here acknowledging I was on a grandfathered plan and knew it, and please take the prepaid Registered return envelope with the documents back to the PO ASAP. I literally LOL'ed and did my penwork, then wandered to the PO.

They were taking it very seriously though - Registered mail, as I learned in my time at Brookhaven National Lab, is an acceptable way to move classified Secret information. That's a pretty heavy-duty way to let me know my plan wasn't gonna change. On the balance, I'm going with BCBS, especially since Patina is a huge group very open to class-action suits.

[Lars39]

86. Darn. A bit more complicated than I thought:

https://www.healthcare.gov/glossary/grandfathered-health-plan/

Depends on when the plan was created.

[jtuck004]

87. ACA Guidance on 90-Day Waiting Periods and Certificates of Creditable Coverage

90 day waiting period max on group plans if I read this correctly, none for individuals. Might want to check on that, or perhaps someone could shed more light...

http://www.mwe.com/ACA-Guidance-on-90-Day-Waiting-Periods-and-Certificates-of-Creditable-Coverage-04-11-2013/?PublicationTypes=0c37aff3-0fa4-487b-ae40-09ee0164a996

April 11, 2013

Recently issued Affordable Care Act guidance clarifies the prohibition on waiting periods in excess of 90 days and eliminates the requirement to issue HIPAA group health plan certificates of creditable coverage after December 31, 2014.

On March 18, 2013, the U.S. Departments of Health and Human Services, Labor and Treasury (the Departments) issued proposed regulations that implement the 90-day waiting period limitation for health plan coverage under the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (ACA). These proposed regulations include technical amendments to existing rules regarding preexisting condition limitations and portability required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations.

Background

The ACA added Section 2708 to the Public Health Service Act, prohibiting eligibility waiting periods in excess of 90 days for group health plan coverage starting with the first plan year beginning on or after January 1, 2014. The 90-day rule applies to all grandfathered and non-grandfathered group health plans and group health insurance issuers, including multiemployer health plans and single-employer group health plans maintained pursuant to collective bargaining arrangements. In August 2012, the U.S. Department of the Treasury, in connection with the U.S. Departments of Labor and Health and Human Services, released Internal Revenue Service Notice 2012-59, which provided temporary guidance on the definition of a “waiting period” and the application of waiting periods to certain types of variable hour employees. This new guidance is generally consistent with Notice 2012-59. Compliance with this guidance or Notice 2012-59 through the end of 2014 is permissible.

...

More at site...

[sir pball]

96. As I said, I think I have a "preexisting plan"

Much better name than "grandfathered" since apparently they can screw you nine ways from Sunday and have it be legal.

Yet another reason for single-payer.

[davidn3600]

67. Which is nice, until people see that MONSTER deductible that has to be met

They go to the doctor, doctor says they need a certain test or procedure. The patient goes to his insurance policy and finds out the insurance won't pay anything because the deductable is thousands of dollars and then opts to not have the test done because he doesnt have the cash in his pocket.

[sir pball]

81. I know what you mean, but a lot of PEs are incredibly expensive anyway

To the point where a $5-6k deductible (mine on a marketplace plan) is still a lot better yearly payment than what they've been dealing with. I don't oppose the ACA but I'm coldly amused by how well you can get fucked by it.

[Lex]

84. There are co-pays along the way. You don't pay 100% out of pocket until you meet the deductible

in the ACA plans.

[progressoid]

76. Who the hell reads formularies?

Most Americans barely understand deductibles and co-pays. Insurance companies know this and know they can exploit people's unfamiliarity with the ins and outs of insurance.

And, find another broker? HA! We had a grand total of 2 in our market. TWO. Shitty and Shittier. We chose the Shitty one.

[geek tragedy]

85. who reads formularies?

my wife depends on an expensive medication so she can walk, so we pay attention

[Fumesucker]

88. Caveat emptor

It's OK if insurance companies screw the stupid and the ignorant, they deserve it.

Yes?

[geek tragedy]

90. yeah, telling people to get the best information possible is exactly

the same as that.

[Fumesucker]

92. But this is the reality you were replying to

Most Americans barely understand deductibles and co-pays. Insurance companies know this and know they can exploit people's unfamiliarity with the ins and outs of insurance.

[geek tragedy]

94. navigating bureaucracy is a challenge

whether it's private or public .

[pnwmom]

157. Single payer systems have formularies, too. And you can't switch to another single payer system

if you don't find your drug on the Medicare, Medicaid, or the UK or Canadian formularies.

Through the ACA, by the way, if you are denied a drug, you can appeal internally and then externally, and there is also a process of requesting a drug exception if recommended by your doctor.

[cyberswede]

91. It's not ok, but they'll do it, given half a chance. nt

[progressoid]

102. You and...?

I'd be surprised if 25% of people research it.

And what happens when (after you have researched & purchased your insurance) you are diagnosed with something that requires a med that was not on your ins plan?

[Cha]

89. Lots of people pay rapt attention to something that so vitally affects them.

[progressoid]

103. And lots of people don't.

Which is how Republicans get elected and insurance companies make millions in profit.

[Cha]

109. Lots of People do.

[progressoid]

111. And the people who don't, get fucked.

Legally.

[Cha]

113. And, the people who do get saved.

[progressoid]

115. So, it's survival of the best insured.

[theboss]

166. Should you have no role in your healthcare decisions?

If we went to single-payer or an NHS model tomorrow, you would still need to know what medicines you need and why. They would not all magically arrive in your mail for free.

[pnwmom]

101. Anyone who needs an expensive drug and can read a list of drugs.

Insurers will provide them upon request.

[progressoid]

107. So,

What happens when (after you have researched & purchased your insurance) you are diagnosed with something that requires a med that was not on your ins plan?

[pnwmom]

112. Insurers can't not include whole classes of drugs. So if you can't continue on one diuretic

then you ask the doctor which of the diuretics on the formulary he would recommend for you. My son's GF did this when she was prescribed certain eyedrops, and the doctor had no problem choosing another from the approved list.

If you have a special situation, and one and only one drug will do, then it's time to appeal. And if you never resolve the situation satisfactorily, next December you can look for an insurer with a better formulary.

But the use of formularies is common everywhere, including in countries with single payer.

http://en.wikipedia.org/wiki/Formulary_(pharmacy)

[progressoid]

114. "next December you can look for an insurer with a better formulary"

For those that live paycheck to paycheck, that should work out great. "Hang on honey, only 9 months to go!"

Like I said upthread, we get to choose from two wonderful providers on the exchange. Of course, we can go outside the exchange, but that is impossible financially for us (and for most people in our financial bracket).

So....fucked then.

[pnwmom]

116. Canada has a drug formulary. The UK has a formulary. I'm not aware of any single payer

system that doesn't have a formulary, are you? It's one of the few ways they've been able to keep costs down.

[pnwmom]

158. Anyone who needs a hugely expensive drug should. That should be a key factor,

along with your choice of doctor, in determining which insurance plan to choose.

Medicare and Medicaid use formularies. So do the national plans in Canada, UK, and around the world. Formularies aren't something special for the ACA.

[Hekate]

97. More light, less heat. Thanks a bunch, pnwmom. nt

[MADem]

110. Thank you for injecting a modicum of sanity into the "discussion du jour."

Well done.

[Number23]

117. +a million

That other post was just about the most unhinged bit of projectile vomit I've ever seen here. Jesus Christ, I'd be beyond mortified to have my moniker attached to that phlem, let alone my real birth name.

I have family members that have been denied coverage, I have been denied coverage. It has never once crossed my mind to blame the PRESIDENT for the immoral actions of an insurance company in all of the years that I've had coverage to complain about.

[MADem]

118. Yeah, I think that was the Fonzie Moment for that fellow.

A real shark jump, and immature, too--so much for the disagree without being disagreeable thing. It's conduct one would expect from a toddler, not someone in their forties with, supposedly, a public reputation. Embarrassing.

[msanthrope]

172. Absloute projectile vomit--and on the second thread, since the OP was locked out

of the first thread he started, the OP was given directions on how to start the appeals process....

Start the appeals process, mind you.

[treestar]

119. Good information

Real and provable rather than anecdotal and something we can't be sure really happened.

[vi5]

126. Maybe instead of convincing DU to clap louder...

..when the fact is most of us are going to vote Democratic and for those who support/supported the ACA, maybe all this effort would be better spent convincing Democratic politicians to embrace and run on the ACA. Convincing them to get out there and run twice as many ads with success stories as the Kochpublican party are running fake horror stories. To start astroturfing facebook feeds with wonderful, heartwarming tales of success that people can forward the same way every idiot Republican does.

It seems fairly pointless to me for people on here to be convincing people on here to do the heavy lifting and work that our Democratic politicians and the party itself don't even seem willing to do.

[ProSense]

127. What do you have against facts? I mean

"Maybe instead of convincing DU to clap louder..."

...when did becoming informed become "clap louder"?

Is correcting the RW distortions about the law convincing them to "clap louder"?

[vi5]

128. Because we know about the ACA.

We know it's flaws and we know it's benefits. We may disagree which one there is more of in the end in this law, but everyone here is fully aware of what it does. Most of us want to make it better and make it go further but I think the amount of people on here who believe right wing talking points about it being socialism and killing people and whatever else are next to none.

My point is that the people on here seem more concerned with countering the lies than our actual elected officials whose jobs rest on it's success, and more concerned than the actual Democratic party that already has a lot of our money and could be using it to counter these lies with ads and success stories.

So my point is instead of trying to convince people who already know about about the law and what it does, maybe the same effort would be spent typing up a letter or e-mail to senators and congressman telling them to get out there adn vigorously tout the benefits of the law. Tell them to use their campaign cash that many of us have already donated to run ads with ACA success stories, of which there are literally millions at this point.

Or you can spend your time making posts on a message board where roughly 90% of the people are already going to vote Democrat anyway and either support the ACA or support making it MORE liberal.

[ProSense]

129. Evidently,

We know it's flaws and we know it's benefits. We may disagree which one there is more of in the end in this law, but everyone here is fully aware of what it does. Most of us want to make it better and make it go further but I think the amount of people on here who believe right wing talking points about it being socialism and killing people and whatever else are next to none.

...not "everyone here is fully aware of what it does." Anyone who thinks the law created the process of formularies is uninformed about what the law does.

[vi5]

130. My point is...

even if someone thinks that one particular point, chances are if they are here on Democratic Underground and not a troll they are already going to vote for someone who supported/supports the ACA.

That still doesn't answer the question: Where are our ads with success stories? Where are the Senators/Congresspersons out there giving full throated support to it and having people on stage with them who benefitted from the law? Where are the abundance of townhalls on the subject going into election season? Wouldn't the effort of the full-on ACA enthusiasts be better off directing their efforts towards the people with actual power and elected responsibilities who seem to be just as afraid and skeptical of the ACA as anyone on this messageboard?

If convincing people is the goal, it's going to take a whole hell of a lot more than posting some shit on a messageboard for Democrats to have it make a damn bit of difference. When we lose the Senate because our elected Democrats are cowards and don't fully support the law, whether or not any of us convinced someone on a message board about one minor fact or truth about the ACA means less than nothing.

[ProSense]

131. The issue

"My point is...even if someone thinks that one particular point, chances are if they are here on Democratic Underground and not a troll they are already going to vote for someone who supported/supports the ACA. "

...is not who will "vote" or "supports the ACA." It's about a vile attack on the President from an uninformed perspective. Let's say someone truly doesn't know that the President has nothing to do with formularies. After learning the facts, that person would remove the vile language. That was not the case. The attacks continued, and were clearly personal and intentional.

[vi5]

132. Got it.

So your concern is not whether the ACA gets maintained, or whether we keep enough seats in the Senate to make sure it doesn't get mantled. Or whether all of these good points about it are trumpeted so that people know about it, or that people are actually helped and can continue to get help in the event that the Republican efforts fail.

It's whether the people on a Democratic messagboard are saying mean things about the President.

Kind of proves my "people on here are more concerned with getting people to clap louder" than they are about actually helping people and making sure the law sticks.

[pnwmom]

136. Sign-up is still ongoing. We need to counter with facts when people spread lies. Even here. n/t

[pnwmom]

134. "WE" do not know. A heavily recommended post yesterday, by a smart and informed DUer,

included false information -- that insurers outside of the exchanges could bar people with pre-existing conditions. And that DU'er's furious and crude anti-Obama post was instantly reverberating all over Freepville.

Another DUer I respect was insisting that under the ACA, people with serious health issues pay higher premiums than people without. All this time, and he had just been assuming that this was the same.

So the level of ignorance here is disappointing -- even with less than 2 weeks to go for signing up.

[pnwmom]

133. This isn't about votes. This is about not scaring people off with only 10 days left to sign-up.

It is pretty shocking to see the level of ignorance that still exists with regard to the ACA. -- and of course that will discourage some people from signing up. In many states, even many people who would qualify for Medicaid aren't signing up.

The time for focusing on the politics is after the sign-up is over, not now.

[grahamhgreen]

137. They should run on turning the ACA into single payer or better:-)

[grahamhgreen]

135. Can you help will Pitt get his meds?

[pnwmom]

138. I think he knows in the cold light of day what he needs to do.

But I offered my opinion of the steps to take in his thread.

[grahamhgreen]

154. Yeah... We need single payer or better still.

[pnwmom]

156. Hopefully Vermont will successfully lead the way,

assisted by the funding they're getting now through the law.

[JoePhilly]

176. I asked if he had tried the National MS Society ...

... because they do help in such situations. They helped a friend of mine.

I provided a link to their website, where they outline their approach to the appeals process, and they provide some materials for doing so.

I got no answer.

[mike_c]

152. in the northern part of my county only ONE provider accepts ACA plans....

The major insurance companies, like Anthem Blue Cross et al, have apparently figured out a different strategy, at least here in rural California. Since they "negotiate" costs with providers, but have all the clout at the table, they've simply set the rates so low that most local doctors simply won't accept ACA patients. There was a recent newspaper article here about the problem-- the insurance companies set prices at 30%-50% of normal reimbursement to providers, who have balked. The only provider here who accepts ACA patients is the local Open Door Clinic, which also treats indigent patients. The only one.

Of course, those same companies sell non-Covered California policies that all the local providers will accept. They're just much more expensive and unsubsidized. So here at least, you can get an insurance policy from the exchange, but you still can't get much in the way of health care, policy or no. Or you can pay through the nose for an individual policy that will get you in the health care provider's door, but which of course most people who stand to benefit from the ACA cannot afford. Sort of takes the affordable out of the Affordable Care Act.

[pnwmom]

155. That is a real problem, unlike some of the lies being told around here.

The anti-Obama poster in another thread yesterday was saying that outside the exchange insurers could bar people with preexisting conditions and that isn't true. The problem is that you can't get subsidies outside them.

Here in WA, I was surprised that when I looked directly at an insurer's website (because my son wouldn't qualify for a subsidy anyway), the information was there -- but customers were told that all the sign-ups were through the Exchange. There was not only no advantage to buying directly, there was no way to buy an individual or small group policy from that company except through the exchange.

[Phentex]

159. I want to commend you...I really do...

for your patience in this thread and for taking the time to try and explain many of the issues to people here who may never have had to be concerned about such things before.

I am no expert on this. What I do know is premiums were being raised by insurance companies long before Obama ran for President. Companies themselves were excluding certain diagnoses from their employer plans so they could save money on insurance. Medications were often dropped from one plan or another and many people had to switch or pay more for their meds. Deductibles could be sky high on many plans but that's all some people could afford. Doctors often dropped plans because they didn't like the rates or the aggravation of dealing with certain insurance companies.

But many people never took the time to understand their policies and in some cases, as long as THEY were covered and liked their plans, they did not seem to notice those struggling with coverage or going without coverage.

Of course, single payer is what we want. But would we rather have that or nothing? The ACA is full of holes. It's crap coverage for some and it's more expensive for many people. But it's a start. And for those who want to scream...I would have clapped for Bush the Turd if he had ever thought to bring about anything like the ACA because it would have been a start.

For the record, I don't see you as some sort of cheerleader/apologist/echo chamber...I see you as an informed person and I appreciate what you have posted here.

[pnwmom]

174. Thank you, Phentex. I have the same basic attitude you do. The ACA has a lot of flaws

but it's a start. And it's a big improvement on what we had before.

And if we can just keep it alive for a few more years, Vermont will show what it can do with the funding the ACA will provide to it for single payer. . . and maybe this will be the real beginning of single-payer. Just like Vermont led the way with civil unions.

Obviously, everyone would like needed change to be faster, but at least we're moving forward now.

[LanternWaste]

163. Thank goodness for insurance companies...

Thank goodness for insurance companies...

[Mojorabbit]

178. I guess you have never picked a company only to have them stop carrying the meds you use

or deny new ones that your doctor orders for you. That has happened to me many times.

[pnwmom]

179. No, it's happened to me, on a large group plan. And it happened to my mother-in-law on Medicare.

This isn't an issue exclusive to the ACA. Medicare and Medicaid have formularies listing approved medications, and so does my state (I was once a state employee), the national health systems in the UK and Canada, and others around the world.

I don't know about the other systems, but under the ACA, there are ways to appeal these decisions. When insurers deny care, there is an inside appeal process, an outside appeal process, and a way for a doctor to request an exception for a drug.

[Mojorabbit]

181. Yes there is an appeal process.

but when you are ill it is the last thing you want or sometimes are equiped to handle. Reams of paperwork and multiple phone calls are the norm, at least for me that was the case.

[pnwmom]

182. But this has nothing to do with the ACA. It's the same way single payer countries

and Medicare and Medicaid manage their drug costs.

[Mojorabbit]

183. I am on medicare with a drug plan through united

It does not have to be this way. The onus should be onthe insurance company to prove why they should not give the patient what their doctor's order for them especially in diseases for which there are few meds available for treatment. The insurance company is not the one diagnosing and treating the patient.

[pnwmom]

184. That's a larger issue, however, unrelated specifically to the ACA ,and it applies to Medicare, too,

even if it has never been an issue for you, personally.

I have only had it happen once on my large group insurance, probably because my doctor has just prescribed the commonly used drugs (I did have to change an asthma medicine, however.) Most people probably have never heard of a formulary until the day they're told their insurance -- whether Medicare of anything else -- won't cover a drug.

[LAS14]

196. Thanks for the work, the info, and for the example! nt

[riversedge]

202. 2014 post. I was hopeful till I saw the date.